The association of body composition on chemotherapy toxicities in non‐metastatic colorectal cancer patients: a systematic review

Abstract

BackgroundIn recent years, certain body composition measures, assessed by computed tomography (CT), have been found to be associated with chemotherapy toxicities. This review aims to explore available data on the relationship between skeletal muscle and adiposity, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular and intermuscular adipose tissue and their association with chemotherapy toxicity in non‐metastatic colorectal cancer (CRC) patients.MethodsA systematic literature search following PRISMA guidelines was conducted in Medline, Embase, Cochrane and Web of Science, for papers published between 2011 and 2023. The search strategy combined keywords and MESH terms relevant to ‘body composition’, ‘chemotherapy toxicities’, and ‘non‐metastatic colorectal cancer’.ResultsOut of 3868 studies identified, six retrospective studies fulfilled the inclusion criteria with 1024 eligible patients. Low skeletal muscle mass was strongly associated with increased incidence of both chemotherapy toxicities and dose‐limiting toxicity (DLT). The association of VAT, intramuscular and intermuscular adiposity was heterogeneous and inconclusive. There was no association between SAT and chemotherapy intolerance. No universal definitions or cut‐offs for sarcopenia and obesity were noted. All studies utilized 2‐dimensional (2D) CT slices for CT body composition assessment with varied selection on the vertebral landmark and inconsistent reporting of tissue‐defining Hounsfield unit (HU) measurements.ConclusionLow skeletal muscle is associated with chemotherapy toxicities in non‐metastatic CRC. However, quality evidence on the role of adiposity is limited and heterogeneous. More studies are needed to confirm these associations with an emphasis on a more coherent body composition definition and an approach to its assessment, especially regarding sarcopenia.

Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis

“…Current studies on chemotoxicity in CRC mainly focus on patient-reported outcomes (PROs) [12,14] and cancer treatment outcomes (e.g., response rates, cancer death) [20][21][22]. In previous studies comparing adverse events between PROs versus clinician-reported outcomes (e.g., grading scales, diagnostic codes, or progress notes) in lung cancer [23], and mixed cancer types [24], patients generally reported symptoms earlier and more frequently than clinicians, had a higher incidence and severity of subjective toxicities, and had poor to modest agreement with clinician-reported values [23,24].…”